Provider Demographics
NPI:1922361062
Name:ALAN REISMAN, DDS, PC
Entity Type:Organization
Organization Name:ALAN REISMAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:REISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-665-2377
Mailing Address - Street 1:1075 S BOULDER RD STE 135
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2559
Mailing Address - Country:US
Mailing Address - Phone:303-665-2377
Mailing Address - Fax:303-665-1301
Practice Address - Street 1:1075 S BOULDER RD STE 135
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2559
Practice Address - Country:US
Practice Address - Phone:303-665-2377
Practice Address - Fax:303-665-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94237743Medicaid